Healthcare Provider Details

I. General information

NPI: 1457916082
Provider Name (Legal Business Name): COLOUR OF HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N MAPLE DR
BEVERLY HILLS CA
90210-3428
US

IV. Provider business mailing address

325 N MAPLE DR
BEVERLY HILLS CA
90210-3428
US

V. Phone/Fax

Practice location:
  • Phone: 949-607-8187
  • Fax: 310-651-1999
Mailing address:
  • Phone: 949-607-8187
  • Fax: 310-651-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name: MISS MONE SHAW
Title or Position: FOUNDER
Credential: BCBA
Phone: 949-607-8187